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Q: Could you please talk about how to (and when to) approach families in which you fear alcohol or drug use is an issue? If a child is in school, is it better to approach the school (counselor or teacher) than to approach the family?

A: Open communication is always the best. If you're close to the family, then speak up in a gentle, caring way to find out if anything is happening to understand what's caused the change in the child you are concerned about. If the child is in school and you're not close to the family, contact the counselor or student assistant specialist with your concern.

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Q: According to the Children’s Alliance of Washington, Native children are 5 times more likely and African American Children are 3 times more likely to be in the child welfare system than Euro-American children. The children of both minority groups stay in the system longer than the children of white families. Yet there is no data indicating that minority children are abused or neglected at higher rates. So what do you believe are the reasons for this disproportionality?

A: Many times, he institutional racism is manifested by lack of publically funded rehabilitation services like substance abuse treatment or mental health counseling services. If these federally required "active efforts" to reunite families are not present or funded in a particular community like the Native or African American communties, the end result will be children staying away from their parents for longer periods and finally being terminated from their families and communities. Another reason is families involved with (the state’s) Division of Children and Family Services sometimes lack the personal financial, physical, emotional and political resources to fight a huge, intimidating system to get their children back.

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Q: How can the state address this disparity in treatment?

A: One of the best ways to address this disparity in treatment has been the formation of Department of Social and Health Services Division of Children and Family Services Indian Child Welfare Units. In Spokane County, we have 3 DCFS ICW units specifically designated to serve Indian families. Many of the staff are also Native and this can be a good strategy to engage families in services. Also, the State of Washington through its' Centennial Accord 7.01 Policy has developed an effective protocol to work with DSHS divisions and tribes and Indian organizations. The state also has a cadre of committed, culturally sensitive communty volunteers through its ICW Child Protection Teams and Local Indian Child Welfare Advisory Committees. The Indian communities across reservations and urban areas in Washington State have put countless hours of time, resources and funding to work together with the State, our vulnerable families and our precious children so we can, as the Lakota chief Sitting Bull said, "Put our minds together to see what life we can make for our children."

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Q: Kids frequently get bumps and bruises in the course of a healthy life. How does a person differentiate between physical abuse and accidents?

A: Sometimes, that can be tricky. It is normal for kids to have a scraped knee or a bumped elbow. But if it's obvious that the child has injuries over a long period of time, or perhaps has tried to cover them up, and when asked says, the same thing over and over: 'I fell down the stairs. I bumped myself' -- those could be causes for concerns. If someone has an injury of some sort, and it's a completely believable story and it happens only once or twice, the internal bells and whistles don't go off.

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Q: What if I don't see physical injuries to the child, but I suspect they are being neglected? What are the signs of neglect?

A: Neglect is perhaps the biggest piece of maltreatment in children. Neglect can show itself with children who are not given food, or come to school very tired because they haven't slept, or have consistently dirty or unkempt clothing. In general, showing lack of an adult's care and supervision in their lives.

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Q: Parents are extremely defensive about the care of their children. If I suspect maltreatment, should I try to intervene with the family myself?

A: Once again, think it through before you take a step. We don't want to cause further harm to the child, and we want to make the situation better, not worse. There are families for whom abuse - either verbal or physical - is the norm. Be careful how you try to be helpful. If the parents are people you know or family members who might respond to a suggestion, then maybe that's the best way to resolve that situation. However, few people will say thank you for bringing this to their attention. A report to the proper agency may be the best way to keep the child safe. Remember that no one is at risk legally for a report to CPS if it is made in good faith. If you see abuse in public, a few suggestions:

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Q: What kind of future do survivors of abuse face?

A: With intervention and good advocacy, survivors can lead a healthy and good life. That's why we encourage survivors to call the crisis line for information and advocacy. This could include medical advocacy, legal advocacy, and emotional advocacy. For survivors and recent victims, each person's experience will be different. Some victims will have minimal damage, and others could sustain lifelong trauma. As we've said in the past, the healing doesn't begin until the talking about it begins.

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Q: What's the first thing that kids and their parents should know about staying safe from abuse, particularly sexual abuse?

A: To listen to themselves. Often, when an individual has a concern about their child or when a child becomes frightened, relavent to abuse, they don't listen to themselves and their own instincts. Those instincts are there for a reason and we all need to learn to listen to them. When that applies to our children, we need to teach them that their instincts are valuable.

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Q: Will it scare my child to talk about abuse? What exactly should I say? How can I talk about such unpleasant subjects when I don't even want her to know about them!

A: It may, and that's not all bad. The important thing to stress is that your child can talk to you. That no matter what happens, there is nothing your child could ever do that would deserve to have someone hurt them. Children need to understand that as we teach them how to stay safe, it does not make them responsible for adult choices that may include hurting them. It is not their responsibility to stay safe. It is the adult's responsibility to keep them safe. When a parent or guardian speaks with a child about staying safe, it can be less threatening to begin by talking about the value of your child and that their body belongs to them. It can also be helpful to start by talking about self-respect. Self respect and helping a child to understand that they DESERVE to be safe and that they can NEVER do anything that deserves any type of abuse is critical. It is not necessary in initial conversations about keeping safe to go into great detail. It is most important to instill a sense of value with the child so they know they deserve to be safe. It is not a lesson, it is a right.

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Q: If my child has been abused, what should I do? Is there anything I should or shouldn't say?

A: First, and most importantly, please, please believe your child. It is extremely uncommon (despite what you may see in the movies) for a child to report acts of abuse when there is no foundation for that report. Children on average, have to report about eight times before someone believes them. Considering what we know, that one in four girls and one in five boys WILL experience child sexual abuse before their 18th birthday, there is absolutely no reason for us, as adults, to require a child to demonstrate such persistence. If a child reports to you, first tell them in clear words that you believe them. Also, tell them that no matter what happened, it was not their fault. Tell them that you will help and then do so. Do not tell a child that you will help and then stay silent. As far as suggestions of what should not be said, do not indicate in any way that the child's behavior, dress, choice of words, choice of friends or anything else that child has done or could ever do would deserve such abuse. This cannot be overstated. Again, the blame for child sexual abuse and any sexual violence, lies squarely with the perpetrator. Do not guess at the outcome of the situation. For example, if you say "That person will go to jail for hurting you," and then they don't, the child will lose more trust and will experience greater trauma. Just tell them you believe them and you will help.

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Q: Is there a particular kind of potential offender a kid or a parent should watch out for? Are there some characteristics common to the perpetrators you see?

A: It is important to remember that you cannot tell just by looking at someone whether or not that person is an offender. An offender does not necessarily fit the profile you might imagine. Offenders come from every walk of life. Children and parents need to be aware that strangers pose the smallest risk when it comes to child sexual abuse. It is far more likely that the offender will be someone the child knows and may love. For this reason, the characteristics may be less important than instilling a child with a sense of value for him or herself. The goal must be to help children understand that no one has a right to hurt them -- even someone they love. That said, there are some characteristics that are more common in offenders. Many pedophiles prefer the company of children to adults. They may experience difficulty communicating in an adult fashion. They may display an unusual attraction to child-related interests like video games, or dolls, etc. They may hang out in places where children frequent. Again, intent is important to remember. Just because a person enjoys being at the park and watching children play does make them a pedophile. If, however, they watch children play with the intent of gaining access to those children, or otherwise satisfying themselves sexually, that person could be a pedophile. If you get the heebee-jeebies, that is not a good sign. Please remember, though, pedophiles and offenders of all kinds against children will never fit into a particular profile every time. You cannot assume that your child is safe because an individual does not display these characteristics. You must be vigilant at all times.

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Q: How old should my child be for me to talk to her about abuse? Isn't it better to wait until she's a teenager, when she'll understand?

A: Please do not wait. It is important to talk with your child as soon as your child demonstrates the ability to understand concepts like "my body" and "touching" and similar ideas. Even if your child is quite young (preschool age) it is very appropriate to talk about self-esteem, the value of his or her body, and that no one has a right to hurt them. This can be confusing to some parents when they try to make sense of issues of parenting vs. issues of personal safety for their child. For example, your child goes to the doctor and the doctor hurts your child with you sitting right there. Sometimes, children become confused that you let someone hurt them after telling them that no one has a right to hurt them. In cases like this, it can be helpful to explain to the child that the doctor is a professional that has to do certain things that may be painful or uncomfortable in order to ensure that the child is healthy. But those certain things are things that a parent will know about usually in advance and that the doctor will do in the parent's presence. There should never be an occasion where a doctor hurts a child or makes that child feel uncomfortable in "secret."

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Q: What effects do different kinds of abuse have on children? Are there specific signs that advocates and counselors look for?

A: It's important to realize that every child responds differently to trauma, depending upon the support they get from their family once the trauma happens. That said, there are some symptoms that seem common in many children. For example, difficulty sleeping, withdrawing, becoming angry, startling easily, difficulty in school and at home. With kids that have been sexually abused, oftentimes they can have a change in their patterns at home and at school where they begin to falter with their grades and become more secretive. They become more emotional and they can actually begin to show signs of trauma. That might include heightened startle reflex, signs of depression and anxiety. A child could have more specific knowledge of sexual things beyond their age level. One physical sign might be that they have burning and tenderness in their genital region. With physical abuse, many of the symptoms are the same as for sexual abuse, however, a child might become more aggressive and act out the physical abuse with peers or siblings. And the opposite: they might become more withdrawn and quiet, afraid to say anything that might cause further abuse. It's also quite common with either physical or sexual abuse to avoid wanting to talk about that. If somebody asked them about it, they might quickly deny it and make an excuse.

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Q: Is there a difference in how you approach treatment for abuse if the abuse is a short-lived incident (like the Groene kids) vs. long-term abuse over time?

A: There are a number of additional factors that come into play with a highly-publicized case. Many more systems come into play such as child protective services, law enforcement and the media, as well as the public's heightened awareness of details they normally wouldn't know about an abused child, which no longer makes the abuse treatment a private matter. Being constantly asked about how you're doing and feeling with people who do not feel safe with can be re-traumatizing. In a case like the Groene case, it would be important to allow as much time as needed for a child to establish rapport with a clinician and feel safe and provide a safe and supportive environment for her to begin to share when she's ready. In addition, she is also dealing with complicated grief which is a combination of trauma with death. These cases tend to take longer and a therapist needs to be more patient while she's working through the details of the trauma. Sometimes this involves stopping and starting when a child becomes overwhelmed with their emotions and needs to manage her feelings before doing any additional talking about the abuse. With a shorter-lived incident, there are still several components, like education about what trauma does to a person; emotional regulation like deep breathing or grounding exercises to help somebody work through really emotional periods; family education, which can help family members anticipate how to support and care for their loved one. And also, carefully processing the trauma and looking into thinking errors that come about when exposed to trauma, like: 'No adult can be trusted," or "I'll never be safe again."

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Q: If I know an adult survivor of abuse, should I encourage them to go to counseling?

A: This depends a lot upon your relationship with the adult that you're speaking of. If it's someone you know well and who trusts you, I think it is fine to encourage them to go to counseling without placing too much pressure on them. This can be delicate matter because sometimes in a person's enthusiasm to help, they have a tendency to have an expectation that they're going to go, and when they don't, they put additonal pressure on them.

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Q: What will happen when I take my child to get help from a therapist?

A: Most programs start with a phone call. You'll be asked to answer general questions about the abuse so that they can determine what kind of help to give you. The second thing that happens, typically, is that you'll go for an initial session, which is an intake assessment that goes into detail about everything from how someone is doing in school to health history and questions about why someone is seeking treatment. Based upon this initial assessment, a treatment plan is formulated to address the issues that the person hopes to deal with. In cases of abuse, this might include a technique which is quite important in Washington state right now: trauma-focused cognitive behavior therapy. This particular technique starts with education about trauma and what feelings and body responses are normal. It also talks about the prevalence of trauma so that an individual realizes that they're not alone and that what is happening to them is a normal response to trauma and not because they're "going crazy." The idea is to get the trauma that is inside a child's head out and to share that with someone so that they're no longer alone with those thoughts. Many other therapy techniques are used such as attachment therapy, EMDR, parent-child interaction training, play therapy or art therapy.

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Q: I've thought about becoming a therapist at some point. What kind of training do you need to become a therapist working with trauma?

A: There are a number of good university programs in the area. I would recommend contacting a number of the programs and asking them about what the ability they have to train you as a therapist. Many of the programs have practicums which give you actual experience working with people. I would encourage you to seek out a program that had a practicum experience. If you want to be a trauma therapist, it's important to realize that you have to have an internal desire to work with this population. This field is one of the most difficult fields to work in for a clinician and it requires a special commitment.

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Q: What exists in the juvenile court system in terms of prevention and early intervention programs?

A: There are two main volunteer programs in Spokane County. The neighborhood accountability board, or diversion program, and the CASA program (court appointed special advocate). The diversion program is volunteers working in teams of two, meeting with first- and second-time offenders who have been charged with offenses like shoplifting, possession of alcohol, malicious mischief. We sit down with a child and their parents after reading the police report and have the child tell us in their own words what happened. We get feedback on how school is going, how they normally get along with mom and dad, we ask about friendships and future goals. We find out if mom and dad impose consequences at home, if this was expected behavior from their son or daughter and if there are other issues they are struggling with. The volunteers then can offer the child a contract requiring them to do community service, pay restitution or attend counseling. These are the same consequences they would be looking at in court, except diversion kids aren't looking at probation time or detention time. It's also true that the contract is not a conviction; that only happens if you go to court and judge finds you guilty. Kids who have been through this system can honestly say "no" if asked on a job application if they've ever been convicted of a crime, although there is a record that they can eventually get sealed and destroyed. This all takes place in a 50 to 60 minute interview and then one of the team members follows up with phone calls until the contract is completed. As for CASA, we're acting on referrals from CPS so the situation has already been investigated. Then we assign a CASA volunteer to do their own independent investigation. They interview the parent, the child, the social worker, relatives, family physician, basically anyone who has knowledge of the child's circumstances. They then submit a written recommendation to the court and testify on behalf of the child for what they believe to be in the best interest of the child. The referrals range in age from birth to 17; the majority are less than 6 years old. We're seeing increasing numbers of referrals with children less than two years old.

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Q: What does it take to become a CASA volunteer, in particular? Do you need any special training, and if not, how do you ensure that they're doing the right thing for the kids?

A: We're looking for people with good communication skills, and the ability to remain objective in the face of situations that are very difficult to be objective about. Everybody goes through a screening interview with me before they get into training. We do a criminal background check, ask for four personal references and continue to screen people throughout 30 hours worth of training. We have huge attrition. If we start with 30 people and have 15 actually activate in the program we consider ourselves lucky. That's partly a self-screening result and we want people to find out before they're done with training if this is not a good fit. And in some cases it becomes apparent that they may have ulterior motives; having had a bad situation with CPS or who have had a friend or relative who did, who don't really want to advocate for kids, they would be better off advocating for parents. The training is based on a national curriculum -- CASA exists in every state -- and among other things it covers topics like the correlation between child abuse and domestic violence, substance abuse and poverty. We take trainees into the courtroom and they all have a turn getting on the stand so we can demystify that setting. We talk about communicating with children and belligerent adults. The most critical component of our training is done by Carol Thomas, a therapist who deals with some of the most damaged kids in the system. And she talks about attachment and bonding, developmental stages of kids, and shares pictures that children have drawn of themselves and their families and she reads the dialog that kids give her describing their families. Very powerful stuff. That's basically as close as we can get to having people understand what they might be dealing with without ever actually giving them a case. Our volunteer base ranges in age from 21 to 78 and it's people from absolutely every walk of life. Homemakers, Realtors, computer gurus, ranchers, people who are good at communicating and have a heart for kids.

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Q: What is the normal outcome with CASA?

A: We ask our CASA volunteers for an 18-month commitment. That's typically the period of time from when a child is referred to us until they are permanently placed, either back with their biological parents, in relative care, or in a foster /adopt home. The majority of children are returned to their biological parents.

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Q: What are some of the ways we know that child abuse winds up taking a larger social and economic toll, beyond the individual victims?

A: We do have a precious few studies that have followed people through their lifespans. There's a really fascinating study done at Kaiser-Permanente that examined the health histories of 13,000 people and identified "adverse childhood experiences," such as growing up in a household where there was child abuse and neglect, violence, substance abuse, mental illness, imprisonment, or loss of a parent. They then tracked the health histories for these people, and found that those who had more than four of these experiences were much more likely to pick up addictive behavior or became obese, and furthermore they had more difficulty recovering from addiction or losing weight. Then those high-risk health behaviors resulted in disease, disability or early death. The reason that was such an important study was that we could see what happens over the lifespan. And of course there's a cost associated with each one of those health conditions. That then documents that these early childhood experiences will end up costing a great deal more in every system -- in the health system, in the education system, in the criminal justice system.

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Q: In the research of the economic benefits of early intervention, what are the one or two key elements that make a difference?

A: Certainly, social isolation is the greatest risk factor. So those programs that are successful in engaging families and getting parents involved in their children's education show the greatest effect over time. For example, Head Start offers stimulating learning activities for the children, but most of the effects on the individual children are washed out by third grade. However, you can still tell a Head Start kid at high school graduation because the program's effectiveness in involving parents has lasted throughout their school career.

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Q: When we talk about early intervention in families, how early is early enough?

A: Before that twinkle in the eye, is what I'd say. I really support programs teaching students in high school about parenting and child care. And certainly the strongest effects have substantiated the importance of engagement during the prenatal period. But here's good news about humans: It's never too late. We're coming to appreciate the wondrous things occuring in the developing child, from the earliest days. But humans don't lose the ability to learn or adapt later in life.

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Q: Some outward signs of abuse may be more noticable than those of neglect. If as a neighbor I saw a bruised child, I would consider a CPS report. But what if a child is just unkempt or listless, or seems unsupervised?

A: This is actually a situation where you may be part of the solution. Rather than a judgmental or investigative approach, some neighborliness might be indicated. What if you struck up a conversation with the child and found out something about his or her interests? What if you had an extra book or basketball that you might offer to the child and get to know him or her better? Certainly if you found that the daily conditions of that child were substandard and in fact he or she was being left alone and unsupervised, then a call to CPS is warranted. But you might find instead that you've helped to create a neighborhood where caring adults can, together, give all the children more feeling of belonging or safety.